Review Question - QID 219807

A 69-year-old Caucasian female from Sweden with a history of chronic elbow pain treated 3 years ago with a total elbow arthroplasty presents to the clinic with the radiographs shown in Figure A, as well as complaints of erythema, swelling, and pain with even minimal range of motion. Laboratory exams drawn prior to her visit demonstrate a hemoglobin A1c of 5.9%, positive rheumatoid factor, negative anti-cyclic citrullinated peptide, a TSH of 10.6, and a free T4 of 0.23. Her clinical presentation and imaging findings are concerning for a periprosthetic joint infection (PJI). Which of the following items from her history is most closely linked to the development of PJI in the setting of total elbow arthroplasty?